COVID-19 UPDATE #14
March 26, 2020
CONVERSATIONS REVISITING END-OF-LIFE WISHES AND ADVANCE DIRECTIVES
In light of the high mortality rate (20-30%) for nursing home and assisted living community residents who become infected with COVID-19, we urge you to: 
  • Have conversations with residents and families about their end-of-life wishes now, before someone becomes ill.  
  • Ensure residents’ advance directives, Provider Orders for Life-Sustaining Treatment (POLST), and other documents are all up to date with current documented wishes, and physician orders are consistent with these wishes. 
 
In the coming weeks, we expect to have hospital surges across the country that will exceed the capacity to transfer nursing home and assisted living community residents with suspected or confirmed COVID-19. Discussing with residents and families now as to how they want to be cared for in place in the nursing home or assisted living community will be helpful to inform how to best meet their wishes, in advance of the anticipated continued spread of COVID-19, and its increased strain on the health care system.
DEAR ADMINISTRATOR LETTER UPDATES ASSISTED LIVING PROVIDERS ABOUT LICENSURE VISITS
DSHS issued a Dear Administrator Letter on March 25, 2020, with updates regarding Residential Care Services licensor visits. These visits are focused on evaluating each assisted living community’s preparation for COVID-19 and generally take about 15 minutes. An infection prevention assessment tool has been provided by DSHS. It is recommended each facility utilize this form to determine level of preparation and areas requiring additional focus.
WATCH OUT FOR COVID-19 CYBER SCAMS
Because Washington State is one of the first states to battle a high number of positive cases of COVID-19, hackers are targeting our area. Individuals are using telemarketing, social media, and in-person solicitation to offer COVID-19 tests to Medicare beneficiaries, among other scams designed to trick people into divulging sensitive information. The Cybersecurity and Infrastructure Security Agency (CISA) warns of scams related to COVID-19 including emails with malicious attachments or links to fraudulent websites to trick victims into revealing financial and other sensitive information or donating to fraudulent charities or causes. Exercise caution in handling any email with a COVID-19-related subject line, attachment, or hyperlink, and be wary of social media pleas, texts, or calls related to COVID-19. Click here for resource information about how you can avoid scams and fraud.
UPDATED GUIDANCE FROM KING COUNTY PUBLIC HEALTH REGARDING EMERGENCY SUPPLY REQUESTS
King County Public Health Department has issued guidance on alternatives to personal protective equipment (PPE) in the event that PPE becomes even more limited or unavailable. This guidance to alternatives is intended for health care providers.
 
If you are a provider in King County and wish to report concerns about a case, cluster, or outbreak in a healthcare or social service setting—including assisted living and skilled nursing centers—please use this online form . The Public Health COVID-19 Investigation Team will review all submitted forms and follow up as needed.
TEMPLATE LETTER TO HEALTH PLANS AND ACCOUNTABLE CARE ORGANIZATIONS REQUESTING RELIEF
The American Health Care Association (AHCA) previously reported that health plans have announced, and CMS is allowing Medicare Advantage plans flexibilities to offer, relief to patients and providers specific to COVID-19-related services. However, due to the extraordinary efforts skilled nursing providers are taking to care for all residents, AHCA has provided a template letter to ask Managed Care Organizations (MCOs) for further relief from administrative burdens including all prior authorizations, all pre- and post-payment reviews, excessive documentation requests, and payment delays.
 
Similarly, AHCA has provided a template letter to use with Accountable Care Organizations (ACOs) to request a reduction in documentation requests, loosening of utilization management strategies, and effective communication and partnership on COVID-19 patients. To use the letters, download the document(s) and include the MCO’s or ACO’s name and SNF’s contact information where indicated, and send the letter to the provider or contract representative at the MCO or ACO.
STAFFING AND LICENSING INFORMATION
Nursing Assistant Training Programs : Restrictions related to COVID-19 have impacted nursing assistant (NA) testing and schools statewide. The Nursing Commission has begun providing approval for programs to shift to a live, online format for classroom content during this emergency proclamation. In addition, the Nursing Commission asks programs to provide federally-required content first, enabling students to apply and work as nursing assistants-registered (NARs) under the supervision of an LPN or RN while they complete the class. Action is underway to lift additional barriers for rapid NA entry into the workforce. You can find the NAR Application and fees  on the Nursing Assistant webpages.

Student Nurses Encouraged to Apply for Nursing Technician Registration During Clinical Site Closures: Most clinical sites are closed consequent to the emergency proclamation and widespread school closures. Nursing students who have yet to complete clinical experiences are encouraged to apply for a Nursing Technician registration.
 
Nursing Technician Registration: The Nursing Commission encourages nursing students who meet the requirements for RCW 18.79.340 and .350 to apply for nursing technician registration . This enables nursing students to assist with nursing duties up to their level of education and documented skill level, under the supervision of a qualified RN.
 
Emergency Interim Permits: When a nursing student has graduated from a nursing program and before they take the national exam (for LPNs, RNs and ARNPs), they can apply for licensure following the online process . After the college/university sends the certificate of completion confirming completion of the program, the licensing unit has received the official transcripts, and the applicant has registered for the national examination, licensing staff can issue an emergency interim permit allowing the applicant to work as a nurse during the declared emergency. When testing is available again, nurse applicants are required to take the national exam to complete the process for permanent licensing.
 
Temporary Practice Permits for Nurses: At this time, the Nursing Commission recommends applying for nurse licensure through the online license application process . Please submit a complete packet of required information to ensure no unnecessary delay. If you are endorsing your license from another state, please complete licensure verification online . We encourage the submission of electronic transcripts; please have your college/university return the transcript to nurselicensing@doh.wa.gov . A temporary practice permit is valid for 180 days, or until the Nursing Commission issues a permanent license. If the emergency extends beyond 180 days, the commission may grant extensions. 
 
No Additional Washington Licensing Requirements for Certain Out-of-State Nurses: Washington’s Uniform Emergency Volunteer Health Practitioner Act ( RCW 70.15 .) permits nurses from Washington or other states with no prior disciplinary history to apply to work in Washington without further licensing requirements. Find information, including FAQs and the application, on the Emergency Volunteer Health Practitioners webpage. The DOH office of Emergency Preparedness and Response manages the placement of nurses based on need. Nurses may accept voluntary or paid assignments. This is not a substitute for Washington licensure and is available only during the time of the Governor’s emergency proclamation. 
 
Can an Emergency Volunteer Health Practitioner be Paid? It depends on any existing contractual relationship between the emergency volunteer health practitioner and the healthcare facility (host entity) for a specific volunteer assignment. Click here for details on when an emergency volunteer health practitioner can be paid.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website . If you have questions or need additional information, please call the WHCA office at (800) 562-6170.